Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial
2. Materials and Methods
2.1. Site Description Section
2.2. Interview Guidelines
2.3. Target Populations
2.4. Interview Conduct and Analysis
3.1. Study Participants
3.2. Screening Practices
3.3. Disease Knowledge Levels and Attitudes towards the Disease
3.3.1. Disease Awareness
3.3.2. Disease Origin Awareness
3.3.3. Disease Prevention Awareness
3.3.4. Perceptions of the Disease and of Vital Prognosis
3.3.5. Known Treatment Options
3.4. Screening Barriers and Triggers According to Women and Practitioners
3.5. The Impact of Social Disadvantage and Cultural Factors on Screening
3.6. Attitudes towards Home-Based Self-Sampling
- Clearly and simply explain the importance of early diagnosis, the availability of non-invasive treatment and reassure regarding prognosis;
- Present a simplified screening schedule;
- Provide other screening options;
- Reassure women on usage through simple instructions;
- Reassure women on quality (results and sample preservation);
- Train local health professionals so that they can better support women throughout the self-sampling process;
- Provide accompaniment options: where to ask for advice in person and a toll-free phone number;
- Provide additional support for women from categories the most at risk or more socially isolated: work with community organisms to reach women with language barriers and those with housing issues; work through the prison staff to reach incarcerated women;
- Integrate HBSS into community health programs targeting socially isolated women.
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Semi-Structured Interview Guide
- I-Socio-Demographic Characteristics and Living Conditions
- Please tell me a bit about yourself?:
- Where do you live? How long have you lived there? Do you own or rent the house you live in?
- Are you married? Do you have someone in your life (if not married)? (If yes) For how long? (If not) Have you ever had a boyfriend? (we need to know if she has ever had sex)
- What do you do for a living? How much do you earn approximately per month? Is it sufficient to support yourself? Do you manage to put a little aside? (If she is not able to support herself) How do you manage (support from brothers or sisters, parents, friends...)? (If married) What is your husband’s occupation?
- Where were you born? How long have you lived in France/Reunion (if born elsewhere)? How did you get here? Where were your parents born?
- Do you have social security coverage? Do you have a carte vitale, CMU (complete health coverage for those on benefits) or AME (partial health coverage)? Do you have a health insurance to cover all or part of your health expenses?
- Have you been to school? If yes, what was the last class you attended?
- Do you have children? How many? How old are they? Do they all live with you?
- II-Knowledge/Perceptions of CC and Risk Management
- (1) Knowledge and Perceptions
- Can you tell me what you know about the uterus and cervical cancer?
- Do you know what the uterus is? Where is it located? What is its role in a woman’s body? The vagina?
- Do you know of any diseases that can affect the uterus? What are these diseases?
- Have you ever heard of cervical cancer? (If yes) Where, with whom and on what occasion? What information were you given?
- Are there any words in your native language for CC? How does it manifest itself?
- What causes cervical cancer?
- How do you think a person can get this disease? Do you know what to do to avoid getting it? What do you do to avoid getting it? Are some people more at risk than others?
- Do you know if this is a curable disease? (If so) what type of treatment is available? Where should you go? (If not) do you think it cannot be cured?
- Do you know any women who have it (or any other cancer)? (If yes) What happened? How close were you to the person...?
- Do you think that medicine can cure cancer? Under what circumstances?
- Have you heard of HPV vaccination? Do you know people who have received it?
- Besides cervical cancer, do you know of any other diseases that only affect women?:
- What are they? What part of the body do they affect?
- What should be done to treat them? What can be done to prevent them?
- Do you know the types of cancer that only affect women?
- Who do you think gets these types of diseases?
- (2) Screening
- How can you find out if you have cervical cancer or not?
- Do you see any value in finding out early?
- Have you even wanted to know if you had the disease? Why? What did you do?
- Do you know what a smear test is?
- What is the point of having a smear test?
- Do you know what the word “screening” means?
- Have you ever heard of a HPV test? What is its purpose?
- Have you ever had a Pap smear? an HPV test?
- At what point in life should women do it? Why should they do it?
- (If you have already had a Pap smear) When? On what occasion did you do it? What prompted you to do it? Did someone encourage you to do it? What does this person mean to you? What was your reaction when that person suggested the test? What words did they use to encourage you to take the test? What words made you hesitate?
- How did the test go? How did you experience the test?
- Where did you go for the test? How did you find out about this facility?
- How did you get your results? How long did it take to get the results? How did you experience the wait? Did you pay for the test? If yes, how much?
- (If no, even though she knows about it) Why did you not want to go for the screening (fear of the result, cost, distance...)? Do you think you will do it one day? Under what conditions would you do it?
- If you could do a test at home, how would you react, would you opt for this possibility? Why or why not?
- Have you ever received a letter inviting you to get tested? What did you think? Who received it? Who read it? What did you do? Did you tell anyone about it? Role of men, spouse, others (e.g., if the woman cannot read...)
- Do you prefer to read in Creole or in French? How would you react to a letter urging you to do a screening in French versus if it was in Creole? Or in both languages?
- What happens when you receive mail: where does it arrive? who receives it? who reads it?
- (3) Practices around the genital area
- Can you tell me what you do to take care of your intimate health?
- Intimate cleaning (after sexual relations...)
- What did you do the last time you felt something was not right? Why or why not? Who do you talk to about it? Do you consult with anyone? (If not) Why? If you consult a health care provider, who do you go to? Why?
- Do you pass on tips between women or between mother and daughter regarding intimate health? What are these tips? What habits were passed on to you? By who?
- In what language are you most comfortable talking about this topic?
- Do you ever consult a midwife or a gynecologist? How often? For what reasons in general? What do you think of the care provided? (If not) Why not?
- Do you ever consult someone else (acupuncturist, osteopath, healer...) regarding your gynecological health? In which cases? What do you think of the care provided?
- In conclusion
- Do you have any suggestions to encourage women around you to get screened?
- Is there anything you would like to add?
Appendix B. Semi-Structured Interview Guide
- Health Providers
- General information
- Age, gender
- Status & role
- Training & experience
- How long have you been working at this facility? Have you changed position since you’re here?
- Can you tell me more about your career so far?
- General information about the facility
- Name and function of the facility
- What does your work/function in the facility consist of (tasks, missions, roles, work structure)?
- Who are the “users” of the structure? (if applicable)
- Perceptions/experiences related to the CC
- What is your experience related to CC?
- What is your involvement in preventing/treating this disease?
- What difficulties have you encountered?
- For general practitioners:
- What is the profile of your clientele?
- Do you conduct gynaecological examinations? Smear tests?
- If not: does he/she encourage smear tests?
- Does he encourage young girls to be vaccinated against HPV?
- CC Screening Services Provided
- What types of services do you offer in relation to CC screening? Since when?
- How many caregivers are trained to provide these services? Have you been trained? If so, since when?
- How is CC screening organized? How does it fit into overall services?
- What is the pathway for a woman looking to be CC screened? How does the screening offer work? Is it done at the request of women, the association that manages organized screening in your region, or at the suggestion of caregivers? (If screening is done at the suggestion of caregivers) What prompts you to offer screening (systematic, suspicion, etc.)? How do women react (refusal, request for time to reflect, immediate acceptance)? If you want to encourage a woman to undergo screening, what words do you use? Why do you think some women do not accept?
- Who conducts the smear? How does the sampling go in general? How do women experience it? What difficulties have you encountered? What do you do/say?
- Where do you send the sample? How long does it take to get the results? How are the results provided to the women (when it is positive? when it is negative?)
- How often do you encounter requests related to CC screening services?
- What other difficulties do you encounter in the prevention and/or management of CC (in relation to the organization of the offer? in relation to the beneficiaries)? What do you do to overcome such difficulties?
- HPV self-testing (knowledge, representations)
- What do you think about HPV testing? and self-sampling? Do you think that home-based self-sampling for HPV can be an alternative to Pap smears? Which women should be offered HPV self-sampling?
- Do you feel you have sufficient knowledge to encourage HPV self-sampling?
- What do you think would be the barriers to implementing such a strategy?
- Are there any potential levers to build on to implement primary HPV self-sampling?
- What is the most appropriate way to provide self-sampling to women who need it? What do you think about sending a kit to women’s homes?
- What is the most appropriate method for collecting self-samples? Should specimens be collected at home? Through health professionals? Pharmacists? What is your opinion on returning the sample to a provider versus returning it by post?
- What do you think about a financial incentive to encourage women who do not participate in screening to self-sample at home?
- Experiences with women
- Do you discuss this disease with patients? How? Systematically? When?
- Do you talk about prevention? Screening? Management? Treatment? With those who are positive or with all patients?
- What do you say to patients when they undergo screening?
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|Place of birth||Reunion||Mayotte||Comoros||Madagascar||Mauritius||Mainland France||Holland|
|Socio-economic criteria||Unemployed||Employed||Retired||Welfare benefits||Single mother||Remote area|
|Factors of sever social disadvantage and isolation||Migrant||Language Barriers||Illiterate||Homeless||Sheltered Accommodation||In Prison|
|Other Criteria||Family exclusion||Disability||Chronic Illness||Gender Based Violence||Sex Worker||Alcoholism|
|Medical Doctors||4||2||1 prison doctor and 5 general practitioners: 2 at MCPCs, |
1 at a screening unit, 2 private sector practitioners
|Gynaecologists||2||2||2 obstetricians working in hospitals, 1 gynaecologist–sexologist working in a screening centre, 1 private sector|
|Midwives||1||5||1 at a MCPC, 5 private sector practitioners|
|Pharmacists||2||2 private sector practitioners|
|Laboratory Practitioners||1||1||1 biologist at a sampling centre, 1 pathologist at an analysis centre|
|Factors of Influence||Barriers||Triggers/Encouraging Factors|
|Knowledge||CC||Not knowing about CC|
Believing CC is incurable
Believing the treatments offered are difficult to bear
|Becoming aware of the disease Believing CC is curable if detected sufficiently early|
Understanding treatment options
Being informed by a practitioner
|Screening||Screening schedule unknown|
|Attitudes||CC||Not feeling concerned by CC|
An invisible disease
|Feeling concerned by CC|
|Screening||Not feeling at ease with the practitioner or the act itself|
An additional burden in terms of time and obligations
Fear of the results
|Feeling at ease with the practitioner and the act itself|
Part of taking care of oneself
Not being able to “see inside” oneself
Wanting to know
|Practices and past experience||Screening||No longer receiving an invitation letter|
A negative screening experience
|Reminders in person or by letter|
Gynaecological monitoring (contraception, pregnancy…)
Integrated into a health routine
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Pourette, D.; Cripps, A.; Guerrien, M.; Desprès, C.; Opigez, E.; Bardou, M.; Dumont, A. Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial. Cancers 2022, 14, 1380. https://doi.org/10.3390/cancers14061380
Pourette D, Cripps A, Guerrien M, Desprès C, Opigez E, Bardou M, Dumont A. Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial. Cancers. 2022; 14(6):1380. https://doi.org/10.3390/cancers14061380Chicago/Turabian Style
Pourette, Dolorès, Amber Cripps, Margaux Guerrien, Caroline Desprès, Eric Opigez, Marc Bardou, and Alexandre Dumont. 2022. "Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial" Cancers 14, no. 6: 1380. https://doi.org/10.3390/cancers14061380